Jonathan Tyler Thayer, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

2024019038 Issued in MO

Practice address

1894 Wentzville Pkwy
Wentzville, MO 63385-3820

Phone

(636) 887-4000

Fax

(636) 887-4095

NPI assigned

May 9, 2023

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

University of Missouri St Louis - School of Optometry, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Clarkson Optometry IncGroup PAC ID 0840411799, 82 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Clarkson Optometry, Inc

  • Optometrist
  • Ellisville, MO
  • NPI 1497155345
  Medicare reassignment Care Compare group NPD
• Clarkson Optometry Inc

  • Optometrist
  • Elk River, MN
  • NPI 1952992976
  NPD
• Clarkson Eyecare

  • Optometrist
  • Eureka, MO
  • NPI 1205817731
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1683590400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747785600000",
    "number": "1124718689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15933 CLAYTON RD",
            "city": "BALLWIN",
            "state": "MO",
            "postal_code": "630112172",
            "telephone_number": "636-200-4393"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1894 WENTZVILLE PKWY",
            "city": "WENTZVILLE",
            "state": "MO",
            "postal_code": "633853820",
            "telephone_number": "636-887-4000",
            "fax_number": "636-887-4095"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6313 Ronald Reagan Dr",
            "address_purpose": "LOCATION",
            "city": "Lake St Louis",
            "state": "MO",
            "postal_code": "633672681",
            "country_code": "US",
            "telephone_number": "636-561-2342",
            "fax_number": "636-561-2362",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "390 Mid Rivers Mall Dr",
            "address_purpose": "LOCATION",
            "city": "Saint Peters",
            "state": "MO",
            "postal_code": "633761565",
            "country_code": "US",
            "telephone_number": "636-279-2020",
            "fax_number": "636-279-1055",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "THAYER",
        "first_name": "JONATHAN",
        "middle_name": "TYLER",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-05-09",
        "last_updated": "2025-05-21",
        "certification_date": "2025-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MO",
            "license": "2024019038",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Savanna Elizabeth Taylor, PLPC
• Ted Beauchamp, DDS LLC
• Alison Marie Tempelmeier, LPC
• Anna Lee Templeton
• Keri M Teter, LPC
• The Child Advocacy Center of Northeast Mo
• The Child Center, Inc
• The Corner Drugstore Inc
• Gina Bertini Theisen, FNP-C
• Brooke Marie Theodorakos, MS, RD, LD

• Optometrist in Wentzville, MO
• Providers in Wentzville, MO by specialty
• Optometrist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.